The city’s public hospital might have broken doctor-patient confidentiality in a recent substance use case announced by the Judiciary Police (PJ) last week, Erick Cheung, member of the Narcotics Control Committee told the Times.
A 22-year-old teacher was apprehended on October 18 by the PJ following a referral from the Public Security Police Force (PSP), for consuming marijuana. PSP, according to the PJ, was notified by the public Conde de São Januário Hospital (CHCSJ), where the patient was seeking medical assistance after feeling discomfort from taking the addictive substance.
Doctors at the public hospital ran a blood test on the patient. The test yielded positive results for marijuana.
However, according to Cheung, in Macau, notifying the police is not the only way to handle such situations. He cited Article 34 of Law No. 17/2009, which, in his opinion, gives medical professionals the option to contact the Social Welfare Bureau (IAS) or the Health Bureau (SSM) for medical support instead.
“This is the spirit [in which] the law was made: to provide adequate and scientific intervention for people with addiction issues,” Cheung posited, adding that he finds it disturbing for a help-seeker to be arrested at the medical facility.
Furthermore, the fear of getting arrested will discourage substance users from seeking medical assistance.
“These fears might eventually lead to avoidance of seeking help for their addiction, overdose or withdrawal issues, [which] turns out to be harmful to what we are purposing with the laws and the mutual supportive network from the helping institutions,” said Cheung.
“If a person is looking for health assistance, then the medical [facility] is obligated to offer those necessary medical services, which has been carried out in the system well in all these years,” he added.
When further asked why criminal investigation is not a more preferred option, Cheung explained that providing medical help will retain the individual’s aptness to live a life. They can go to work and earn income as usual, so that they can support their own life.
“[It is more so] for mild or moderate users who are yet maintaining functional scope of life,” Cheung said. “[Apprehension] just pushes the person away from their well-being and deepens the chance of increased substance use, fitting the label of a criminal, but not a person who is seeking for change, either in terms of health, behavior or choice of life.”
He did not understand why the police were notified this time. “Entities between health, social welfare and even sometimes the judicial branches, are cooperating well in these intra-sector referrals to bring appropriate help to the people who need it,” he revealed.
When asked by the Times as to under what circumstances the police should be notified by a medical professional during medical consultation, Cheung thinks that the police should be informed when a patient is causing immediate life-threatening harm to themselves or others.
“I would say drug trafficking, human trafficking or [posing] danger to other people, such as driving under the influence of drug or alcohol would be feasibly obligated to be reported,” Cheung said.
A psychological counsellor himself, Cheung reiterated that handling substance users in a criminal manner is not the best way. “We should always be reminded about pushing people who use drugs – excluding those who sell them – under criminal charge does not help with their addiction but always likely to ruin the social functioning of the person,” he explained.
Cheung argues that the Macau community has built up an effective and efficient system for years, which involves essential professional referral. It is, according to him, more appropriate between sectors of health and social welfare.
Entities in Macau – both public and private – have been working on the prevention and treatment for individuals who use drugs or substances on a regular basis or with addictive tendency.
As neither of Dr Tai Wa Hou nor Dr Lei Wai Seng, both medical directors of the CHCSJ, were at the regular health press briefing last Thursday, the Times emailed the SSM after office hours the same day for a comment. None was received by press time.
A lawyer’s view
Despite Cheung’s argument, local lawyer Vítor Tang considers the same provision debatable. Speaking on the legal provision in general, the lawyer suggests further clarifications may be needed.
This law only states that the medical team, during the treatment, should not disclose the patient’s “particulars.”
“Reviewing the Portuguese version, I have the interpretation that the medical staff should not disclose the name of the patient,” Tang said. “It doesn’t mean that the doctor has no responsibility in notifying any illicit details to the police.”
He also referred to the Criminal Procedure Code to support his understanding. “Pursuant to Article 225 of [the Code], certain individuals are obliged to report any illicit deeds found during their work, with civil servants being one of them.”
On the contrary, after reviewing the legislative documents stored with the Legislative Assembly, Tang said that the Code and Law No. 17/2009 (the Law) are somehow conflicting.
“My understanding is that the provision [in Law No. 17/2009] only concerns those with medication reliance, who seek medical assistance in the hopes of treating the said reliance,” the lawyer said. “Only then the duty to report any illicit doings is waived by Clause 4, Article 34, Law No. 17/2009.”
Referring to the legislative documents, the law, as part of a wider public health policy, aims at encouraging substance users to seek medical assistance against their medication reliance, the lawyer said.
Furthermore, the wordings in the Law are also unclear. “The chapter comprising the provision uses the phrase ‘Prevention and Treatment of Medication Reliance’, but Clause 1 of the provision has no reference to ‘medication reliance,’” Tang pointed out. “Rather, substance users are referred to as ‘drug takers.’”
The manner in which the provision was written is also confusing, as Tang described. He said that Clause 1 of the provision seems to provide room for interpretation. It states that confidentiality may kick in when a substance user “approaches medical care”, “but it is not clear if, for example, this condition is applicable when the user is getting their flu treated,” Tang added.
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